Good results by Staying Strong sees telehealth expansion

Written by Kate McDonald on 04 June 2015.

Community care provider integratedliving is rolling out telehealth services to 13 different regions in four states following the success of its Staying Strong telehealth project, which trialled in-home and hub-based monitoring of vital signs for older Aboriginal and Torres Strait Islander people.

integratedliving has now received funding from the federal government through what was formerly known as the Home and Community Care (HACC) program to expand the project into an ongoing service in NSW, Queensland, the ACT and Tasmania.

The company, which predominantly works with older people and people with disabilities in regional and rural areas, first began the Staying Strong trial as part of the NBN-Enabled Telehealth Pilots Program in 2013.

One group received a tablet device and a range of Bluetooth-enabled peripheral equipment along with remote monitoring by a telehealth nurse in their home.

The second group attended “hubs” set up in association with Aboriginal community health centres which provided a dedicated space for telehealth monitoring and storage of the hub equipment for people who did not have adequate internet connectivity at home.

The main aims were to see if remote monitoring could be used cost-effectively in regional areas but also to test the acceptance of the technology by indigenous people. On both measures it was successful, an independent evaluation has found.

The project included 136 older Aboriginal and Torres Strait Islander participants in total, all aged over 50, 90 per cent of whom had five or more chronic health conditions, the most common being high blood pressure, type 2 diabetes and high blood cholesterol. Thirty per cent reported that they had been admitted to hospital at least once in the previous 12 months and all but three participants took daily medications.

An individualised monitoring plan of each person's vital health parameters, acceptable margins and frequency was designed by their regular GP or a registered nurse. Measurements were taken by the various Bluetooth devices, with Tunstall's monitoring software then transmitting the person's health data to the ICP triage manager patient management system. Any readings of of concern were then remotely triaged and followed up by the integratedliving telehealth nurses.

Participants were guided through the process by a touchscreen monitor that uses large visual symbols and a voice element that asks questions of the user in short and simple phrases, prompting the selection of an option on the touchscreen.

According to the independent evaluation, the kinaesthetic or tactile nature of the interaction with the monitor particularly suited many of the participants as it matched older Aboriginal people's auditory and visual, rather than text-based, learning style.

In fact, the evaluation says these findings indicate there is a very high potential for telehealth in rural and remote areas to improve the health of older Aboriginal people.

integratedliving CEO Catherine Daley said the implications and benefits of the Staying Strong project were “powerful”.

"The pilot has shown telehealth can be useful in reducing the cost burden of healthcare," Ms Daley said.

"More importantly, Staying Strong facilitated the development of strong and effective partnerships with Aboriginal organisations and communities, which was vital not only to the successful attainment of the project objectives, but also for enhancing opportunities to continue to support older Aboriginal people."

In addition to suiting their style, the participants loved it. Only six withdrew and 98 per cent said they enjoyed being part of the project. In several instances, participants were quickly referred to their GP or advised to go straight to hospital due to the trends in their vital signs, and there were also a number of cases in which individuals were able to spot a concerning trend and manage it themselves.

Taking part in the project, having the equipment in their homes and its ease of use also instilled a sense of pride in the participants, the evaluation found.

In terms of cost effectiveness, the trial found that remote telehealth monitoring costs less than half that of the traditional visiting nurse model and would be a cost-effective way to deliver better health outcomes to people living in regional, rural and remote Australia.

The estimated cost of face-to-face delivery of in-home vital health signs monitoring for five days a week by a registered nurse is approximately $347.82 per participant, integratedliving says.

However, the weekly average cost of delivering remote telehealth monitoring in participants’ own homes for five days a week was $137.52 per participant, or 40 per cent of the traditional model.

“The cost of the face-to-face delivery model increases when the RN has to travel greater distance in more rural areas,” the evaluation found. “The high cost of face-to-face monitoring, usually results in less frequent monitoring by RNs, or periodical monitoring when the participants visit their clinic or doctor for routine health checks."

Tunstall's corporate development manager Lisa Capamagian said the success of the trial provides evidence that telehealth should be considered in new models of care that will lead to the mainstreaming of telehealth for aged, community and social care.

integratedliving has now been able to roll out mainstream telehealth nursing services on a bigger scale, covering 13 regions across NSW, Queensland, the ACT and Tasmania.

Ms Daley said the expansion of the telehealth service was part of the company's commitment to eHealth and to facilitating health and well-being in the community as part of its service model, which it has dubbed “Embracing Life”.

“With the consumer-directed care philosophy comes enabling and re-enablement,” she said. “It’s really about client choice and control and about facilitating people to make choices.”

Part of the trial's focus was to see what were the barriers for older people in the community, particularly indigenous elders, to using technology to access assistance. It also wanted to find out what would interest people in using the technology.

“The research found that there were really very few barriers to using the technology, which was great,” Ms Daley said. “People kind of assumed that older Aboriginal people won’t use [technology] or wouldn't want to do it, but that wasn’t the case at all.”

Ms Daley said working closely with community members and Aboriginal health organisations on the pilot, along with an intergenerational project that accompanied the trial, meant that the participants felt supported. Family members also became integral to the use of the technology and would often help their elders with their monitoring.

Many of the participants in the pilot are continuing to receive telehealth assistance but it is now open to other integratedliving clients. The company has also appointed former RDNS telehealth manager Mat Tyler to further expand its eHealth offerings.